09 - Rhazes and Arabic Medicine

9. Rhazes and Arabic Medicine

Predominance of Greek influence on world medical thought covered the millennium from 500 B.C. to 500 A.D. The next millennium, between 500 A.D., may be characterized as the medieval period of medicine- a time of great strife, of sociopolitical change, of regression and progression. It was a time- crucible in which classic traditions of the defunct Roman Empire, practices of barbaric paganism, philosophies of rapidly growing Christianity, and the vigorous thirst for knowledge that followed the dramatic rise of Islam were amalgamated. Medieval medicine borrowed elements from all these sources in varying degrees, and passed on to succeeding eras a corpus Medicus the better for this wedding of widely divergent systems.

During the early middle Ages, Western Europe was engulfed in wave after wave of conquering barbarians, who ruthlessly destroyed libraries and centers of learning. No less destructive to life and morale were waves of epidemic plague that swept the Western World. During these centuries, Greco-Roman medicine, grown sterile following the time of Galen, was virtually lost to the Western World. Only those works laboriously copied and preserved by the monks in Christian monasteries remained- and these were hidden behind the walls of scattered cloisters. Although carried on as an accessory to their sacred mission, writings pf monks reflected the more practical aspects of monastic medicine, and were helpful in maintaining cloister infirmaries and herb gardens. The period of monastic was officially closed when the Council of Clermont in 1130 forbade the practice of medicine of monks.

The force which was to change the course of medicine in the Western World, and to restore to it the lost legacy of the Greco-Roman period, was the impact of Arabic science.

In little more than one hundred years after Mohammed’s flight from Mecca (622 A.D.), Moslem Arabs had conquered the Near East, North Africa, and Spain and by 737 A.D. they had reached the banks of the Loire in France. Their ideologic conquest of Greek legacies of science and classics was no less rapid.

Knowledge of the Greeks in medicine as in other fields, came to the Arabs through Christian sectarians (such as the Nestorians) who were driven out of the Byzantine Empire, center of learning when Rome declined and Christianity became the dominant religion. Scholars among these early displaced people translated Greek authors’ writings into Semitic languages, first Syriac and Hebrew, then Arabic. Thus Arabs became familiar with, and enthusiastically embraced, the teachings of Hippocrates and of Galen. By the tenth century all essential Greek medical writings had been translated in Damascus, Cairo, and Baghdad, as had more Greek classics than the West knew of before the Renaissance. The Arabs then began adding their own discoveries and observations to the written body of Greek tradition.

There is little doubt that Arabic medieval civilization was more highly developed than was that of the contemporary West. One of the reasons therefore might have been the great tolerance wisely exhibited by Arabs during their earlier medieval period. Many famous “Arabic” Physicians actually were Syrians, Persians, and Spaniards, Jews, or Christians writings in Arabic. This was true not only in great centers of the eastern Arabic world, but also in Arabic kingdoms in Spain. Constant traffic between the Eastern and Western Caliphates kept both areas well informed on translations of old ideas and on new developments. It was by this long detour through the Near East, North Africa, and Spain, that Greek medical lore returned to Western culture, carrying with it the cumulative contributions of Arabic scientists.

How greatly the West profited from its contacts with Arabic civilizations in all fields is evidenced by the fact that we still use the numeral system which Arabs adapted from India; and many of our everyday words, such as algebra, alcohol, and the like, a re of Arabic origin. In the twelfth century, especially through schools in Sicily and Spain, Latin translations of great Arabic medical books based on Galen and Hippocrates became available to the West; and up until the sixteenth century, Arabic authors were the highest medical authorities in new Western universities, such as Montpellier and Bologna. Arabs, Jews, and Christians, alike, regarded Avicenna and Rhazes as the greatest Arab medical authors. Today, the works of Rhazes generally are considered of somewhat greater significance than those of Avicenna, because of Rhazes greater inventiveness and attention to observation. This evaluation, however, is opposed to that given these writers during the Middle Ages.

Abu Bakr Muhammad ibn Zakuriyya, or al-Razi, known to the West as Rhazes, was born in the Persian city of Rai, about 865 A.D. Up until his thirtieth year; he seems to have been primarily concerned with music, physics, and alchemy. During a visit to a Baghdad hospital, he is said to have become so interested in medicine that he decided to devote the remainder of his life to this profession. He studies with the Jewish physician, Ali ibn Sah al-Tabari, who was well versed in Greek, Persian, and Hindu medicine. After having been director of the hospital in his home town, in about 907 A.D. Rhazes became director of a large hospital at Baghdad and a court physician as well. He seems to have traveled widely, visiting Cordova, Jerusalem, and various cities in Africa. He became famous as practitioner, teacher, scholar, and benefactor of the poor.

Rhazes is supposed to have written 237 books, of which only 36 have survived. Therein he dealt with all the sciences, but his greatest interest was medicine. In his theories, Rhazes was a Galenist; in practice, he seems to have been guided more by the principles of Hippocrates. He showed great independence and originality, and his texts were spiced with descriptions of personal observations.

Most famous of Rhazes’ works was the Continens, a kind of medical encyclopedia, put together from his notes after death. A shorter encyclopedic work is the book dedicated to Persian Prince Almansor. However, the work most highly regarded today is Rhazes’ little book on smallpox and measles- on of the few to have been translated into English. The great merit of this book is that it offers the first medical description of these two important infectious diseases. Although hum oral theories cited impress today’s reader as queer, and although Rhazes did not fully differentiate the two diseases, the clinical descriptions are clear and concise. The volume is concerned mainly with therapeutics.

Writings of Rhazes contain ingenious and penetrating observations on topics as widely variant as hiccough, purgatives, spinal injury, and embryotomy. He made other practical contributions to medicine, such as introduction of mercury compounds as purgatives (after having tried them on monkeys); introduction of lead ointment; and ligature with sutures made from animal gut. He was perhaps the first to observe and to record reaction of the pupil to light. Rhazes urged use of cold water in inflammatory fever, and insisted that treatment for fever be based upon its causation. His book on the “habit which becomes natural” might be regarded as an early though imperfect sketch of conditional reflex.

Evils of quackery were subjects of bitter attack, and Rhazes wrote much about them. He also discussed careless practices of physicians which sometimes caused patients to turn to quacks.

Rhazes contributed the first known book on children’s diseases, and a book on “cure within the hour” which must have been immensely popular. He described an instrument for removal of foreign bodies from the esophagus, and invented a lead catheter which he preferred because of its flexibility. His treatise, “A Dissertation on the Cause of the Coryza which occurs in the spring when the Roses give forth their scent,” is the earliest known description of hay fever.

A man of deep sympathy, Rhazes could not endure poverty and suffering: and, though he earned large fees, he gave away so much that he himself died in want and in poverty. During the later years of his life he was blind, supposedly as a consequence of a blow on the head delivered in anger by Prince Almansor. Apparently he suffered from cataract, but refused operation, saying that he had seen so much of the world that he was weary of it. Though records are vague, Rhazes is believed to have died around 925 A.D.

Eve after more than a thousand years of medical progress, Rhazes’ works and accomplishments command admiration of medical scholars of today.

The torch of Arabic medicine was carried to further heights by Avicenna (Ibn Sina, 980-1037), another Persian writing in Arabic physician, pharmacist, poet, philosopher, and stormy career politician. His great Canon, called the most famous medical textbook ever written, was but one of more than one hundred medical treatises which he wrote.

In the Western Caliphate, the names of Aver roes (Ibn Ruschd, 1126-1198) and of the Jewish physician and philosopher Maimonides (Musa Ibn Maimun, 1135-1208) were among the brilliant lights of medieval medicine.

Capture of Cordova in 1148, by primitive, bigoted, and rigidly orthodox Moslem Almohades, sounded the death knell of Arabic science and medicine in the West; and, in turn, the Eastern empire were accumulated intellectual treasures destroyed, but nearly all scholars and learned men were pitilessly murdered. In the West, however, the Almohades in turn fell before Christians. Fortunately, Christians did not destroy the culture of Islam but absorbed most of it, to the benefit of succeeding generations of medical men.

“Islamic medicine and science,” says Meyerhof, “reflected the light of the Hellenic sun, when its day had fled, and they shone like a moon, illuminating the darkest night of the European Middle Ages. Some bright stars lent their own light, and that moon and stars faded at the dawn of a new day- the Renaissance.”

THE PICTURE

Rhazes (circa 865-925 A.D.), Persian-born physician who wrote extensively in Arabic, is pictured at the bedside of a young patient afflicted with measles. First to describe measles and smallpox with clinical accuracy, Rhazes also was first to observe and report papillary reaction to light. He also wrote the earliest known book on pediatric care. Representing Arabic medicine at its best, Rhazes’ accomplishments of more than a thousand years ago still command admiration.